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Corporate Functions & Operations WellCare - Operations Support Careers

Operations Lead Job

Full Job Title: Operations Lead

Job Number: 1806441

Location: Tampa, FL

Date Posted: 2018-09-14

Responds to member, provider and regulatory agencies’ inquiries and escalations (phone, written, or walk in) regarding all aspects of WellCare business within Operations in a professional, timely, accurate manner while consistently meeting all regulatory guidelines. Coaching and training new team members in addition to veteran associates. Serves in a limited leadership capacity as a subject-matter-expert, mentor and coach.

Location: Idlewild Ave, Tampa, FL

Department: Ops-Complaint Resolution

Reporting to: Supv, Operations

Essential Functions:

  • Responds to basic member, provider and other inquiries via telephone, correspondence or lobby walk-in while meeting all corporate guidelines and performance standards.
  • Acts as a primary contact for escalated calls and/or escalated issues in which special care is required to enhance WellCare relationships with members and providers.
  • Acts as a mentor to associates. Provides real-time feedback as appropriate for the job function.
  • Acts as a Subject Matter Expert (SME).
  • Works with department management to maintain daily workflow within the department in order to maximize productivity. Assists in the development of long-range goals and drives through to completion.
  • Handles issues that require additional research and/or special handling including regulatory, congressional, trust, marketing, sales, executive office, Centers for Medicare and Medicare Services (CMS), etc.
  • Investigates problems of an unusual nature in the area of responsibility in order to identify root cause. Presents proposed solutions in a clear and concise manner.
  • Logs, tracks, follows-up and appropriately documents all issues utilizing on-line systems and procedures, and in accordance with all applicable guidelines and requirements.
  • Acts as a liaison between internal departments on data gathering and problem solving.
  • Works with external organizations (i.e., Social Security Administration (SSA) and CMS) to help resolve member and provider problems.
  • Drives and supports WellCare initiatives at the team by interacting with peers and other internal and external business partners while demonstrating a willingness to conform to WellCare policies and procedures.
  • Assists in the education of new members or providers and in the re-education of existing members or providers regarding health plan procedures.
  • Demonstrates expertise within all assigned LOB’s.
  • Performs skills necessary to create a high-quality customer experience, as reflected through acceptable C-Sat scores, quality monitors and member feedback.
  • Logs, tracks, resolve and responds to state regulators and market inquiries.
  • Assists with other projects and duties as assigned.
  • Performs production related work as necessary.
Additional Responsibilities:

Candidate Education:

  • Required A High School or GED
  • Preferred An Associate's Degree in a related field
  • Preferred or equivalent work experience
Candidate Experience:
  • Required 3 years of experience in a related field based on Operational area
  • Preferred Other Previous experience in a healthcare environment
Candidate Skills:
  • Intermediate Ability to effectively present information and respond to questions from families, members, and providers
  • Intermediate Demonstrated interpersonal/verbal communication skills
  • Intermediate Ability to create, review and interpret treatment plans
  • Intermediate Other Ability to read, analyze and interpret verbal and written instructions
  • Intermediate Other Ability to write business correspondence
  • Intermediate Other Ability to apply sound judgment and decision-making skills in dealing with a variety of routine and non-routine issues
  • Intermediate Other Seeks to build trust, respect and credibility with all partners through full, honest, consistent, and coordinated communication
Licenses and Certifications:
A license in one of the following is required:
  • Preferred Other Customer service, quality or training certifications
Technical Skills:
  • Required Intermediate Microsoft Outlook
  • Required Intermediate Microsoft Excel
  • Required Intermediate Microsoft Word
  • Required Intermediate Other Proficiency with all WellCare Based Systems utilized in job-function
  • Preferred Other Other Languages

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Last Updated On: 12/9/2015